VARIABILITY IN SERUM PEPSINOGEN LEVELS IN AN ASYMPTOMATIC POPULATION

Objective: To investigate the variability in serum pepsinogen levels i n an asymptomatic population. Design: Cross-sectional survey of 420 me n aged 18-63 years, without symptoms or a history of gastric disease, recruited from four factories in Stoke-on-Trent. Methods: During an in terview, data on history of gastric health, 'lifestyle' and occupation were collected, blood samples were taken for measurement of serum pep sinogen and anti-Helicobacter pylori antibody levels and height and we ight were measured. Results: Extreme (low/high) levels of pepsinogens A and C, indicative of chronic gastritis, were found in 24 (5.7%) and 61 (14.5%) of the participants, respectively. Low A-C ratios, indicati ve of moderate or severe gastric atrophy, were found in 13 (3.1%) part icipants. Of the variables examined, Helicobacter pylori serology had the strongest influence on serum pepsinogen levels. Serum pepsinogen A and C levels were significantly higher in the 33.6% of participants w ho were seropositive. The effect was more marked for pepsinogen C; thu s, A-C ratios were lower in seropositive individuals. In seronegative participants, both pepsinogen A and pepsinogen C levels increased with increasing age; pepsinogen A levels increased with increasing height and were higher in smokers, but decreased with increasing weight. The effect of smoking on pepsinogen A levels was also detectable in seropo sitive individuals, but was considerably less marked. Among seronegati ve participants, those employed on the 'shop-floor' in manual jobs had higher serum pepsinogen C levels and lower A-C ratios than office-bas ed workers. Conclusion: H. pylori serology was a major source of varia tion in serum pepsinogen levels, but causes of gastritis other than H. pylori were indicated. Independent of these effects, serum pepsinogen levels may also vary with ape, height and weight. Screening of serum pepsinogen levels in the general population may identify 5-15% who req uire further investigation. Other 'filters' may be required in conjunc tion with serum pepsinogen levels to identify those needing investigat ion for significant gastric pathology.